Healthcare Provider Details

I. General information

NPI: 1780805184
Provider Name (Legal Business Name): MAURY D KELISKY MD ING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-3456
US

IV. Provider business mailing address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-3456
US

V. Phone/Fax

Practice location:
  • Phone: 415-346-7200
  • Fax: 415-346-7517
Mailing address:
  • Phone: 415-346-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANA KELISKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-346-7200